Wake Forest Trains Telehealth, RPM on Social Determinants of Health, Stroke Care

The Wake Forest School of Medicine is launching five separate projects that will use telehealth and remote patient monitoring in determining how social determinants of health access to care.

A sixth new program, meanwhile, will use telehealth to address blood pressure management at home for stroke survivors.

The North Carolina-based health system is using a $2.8 million award from the Duke Endowment to finance the studies, which target non-clinical factors – such as geography, culture and economic status – that may hinder how people access care. Connected health tools and platforms are often seen as a means of addressing social determinants of health, but they could also create barriers if they’re no used properly.

In one program, Wake Forest providers are teaming up with Atrium Health to expand the Super Supporter Program, which was piloted during the coronavirus pandemic to help patients access virtual care in place on in-person visits. The program is using a $919,000 grant for a three-year project that will use patient navigators to reach out to vulnerable populations and help them learn how to access and use telehealth.

“Nowadays, access to the best care means both in-person and virtual care,” Thomas Houston, MD, a professor of internal medicine at Wake Forest and a co-principal investigator of the program, said in a press release. “We hope this new program will help vulnerable groups to access all the care they need.”

The health system’s Division of Public Health Sciences, meanwhile, is getting $630,000 to test the value of a remote patient monitoring program for new mothers.

The three-year project targets hypertension, a common concern among women who’ve recently had children and a leading cause of perinatal morbidity and mortality in underserved populations. The program will equip new mothers in Forsyth County who give birth at Wake Forest Baptist Health with Bluetooth-enabled blood pressure cuffs and an mHealth app loaded into their smartphone that will enable them and their care providers to track blood pressure and manage care.

The other three programs address aspects of mobile integrated health, or services that may combine home health, home visits and connected health.

Wake Forest’s Value-Based Care and Population Health Program is getting $311,000 to support a two-year study of its new community paramedicine program, which sends specially trained paramedics and other care providers to the homes of recently discharged patients with complex chronic care needs to help them manage their care at home, sometimes through virtual visits. The funding here will be used to add more paramedics and nurses to the program.

Jennifer Houlihan, the program’s vice president and a co-leader of the project, says community paramedicine has the potential to improve health outcomes and reduce costs from unnecessary hospitalizations by helping at-risk patients at home, both in managing their conditions and linking them to their primary care providers.

In addition, the Gerontology and Geriatric Medicine Department is getting $530,000 for a three-year program that will send community health workers to the homes of frail older adults to help them learn how to manage daily activities. And the Department of Pharmacy at Wilkes Medical Center is getting $450,000 for a two-year program to improve access to care for uninsured residents of Wilkes County.

In a separate news release, Wake Forest announced the receipt of a $29.9 million, six-and-a-half-year grant from the Patient Centered Outcomes Institute (PCORI) to study how telehealth can be used to manage care for people who’ve had a stroke within the past six months.

“Using telehealth was necessary during the COVID-19 pandemic,” Cheryl Bushnell, MD, stroke division chief and a professor of neurology at the Wake Forest School of Medicine, said in the release. “And we believe telehealth could be an effective strategy for managing patient risk factors, specifically lowering blood pressure to targets that ultimately reduce the risk of recurrent stroke and cardiovascular events.”

The program will compare and contrast Intensive Tailored Telehealth Management (ITTM) and Intensive Clinic Management (ICM) interventions, the former of which involves an mHealth-enabled blood pressure cuff, individualized coaching and virtual care.

Along with Wake Forest, others participating in the study are the University of North Carolina Medical Center, Duke University Medical Center, the Medical University of South Carolina, Health Sciences South Carolina, Vanderbilt University Medical Center, Mayo Clinic Florida, the University of Alabama Hospital and Tennessee’s Erlanger Health System.

It continues a collaboration between Wake Forest and UNC’s Gillings School of Public Health called the Comprehensive Post-Acute Stroke Services Study (COMPASS), launched in 2015 via a $14 million PCORI grant.

“This study leverages advances in technology to enhance remote patient-clinician interaction around the common problem of blood pressure management that could have an impact on clinical practice of stroke care, as well as other conditions,” Wayne Rosamond, PhD, a professor of epidemiology at UNC Gillings and a co-investigator, said in the press release.

“Stroke is one of the leading causes of death and disability, and high blood pressure is a modifiable risk factor,” added Bushnell. “No matter which intervention proves most effective, we believe this trial will have a major impact on blood pressure management in stroke patients, especially in under-represented minorities, the elderly and those with residual disabilities.”